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General NPI Number Information
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NPI Number | 1699069880
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Entity Type | Individual
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Provider Name | MANALI AJAY BHAVE MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2011
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 251 E HURON ST NORTHWESTERN MEMORIAL HOSPITAL
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 224-420-1103
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Fax |
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Provider Business Mailing Address
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Address Line | 220 E ILLINOIS ST APT 1106
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City | CHICAGO
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State | IL
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Zip | 60611-4365
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Country | US
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Telephone | 224-420-1103
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125059165
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | -
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 080666
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License Number State | GA
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